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Any realistic alternatives to surgery for severe lumbar stenosis?
63 year old male with various older guy health issues but otherwise fit and active (weights, softball, tennis, walking). Had some left buttock pain in summer '24 at the very beginning of activity but went away. Fall 2025 it came back more regularly and it became more painful and disabling and sometimes including sensations down the left leg.
Finally diagnosed via MRI as severe stenosis at L4/L5 with some disc slippage or whatever to boot. Orthopedist said I likely need surgery and sent me to spine surgeon. Surgeon said I likely did, but could first try an epidural injection and perhaps some PT. Epidural injection provided a moderate amount of relief for about 3 weeks, then back to living on advil. Surgeon said laminectomy with spinal fusion is next step whenever I'm ready for it. (Haven't tried PT since both surgeon and epidural doc said it wasn't going to truly fix anything and I've always hated PT anyway, but did schedule an appointment for that too.)
Like most people, I don't want spine surgery, particularly any that includes "spinal fusion". Do I have any real alternatives here?
I'm read about somethigng called MILD and other versions of minimally invasive procedures but don't know if they are legit or not, and if they are, if my particular condition could be fixed that way. I've scheduled both a second opinion with a regular surgeon and at two other places that supposedly offer the MILD type procedures.
Anyone with any experience with any of the above, please share your thoughts. Thanks.
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@willow5
We could be twins, same age same symptoms, etc. and I know and can get to UCSF. Which doc did you see? I live 200 miles away from the city in the eastern sierra but have family in PAC heights neighborhood.
I am managing with PT but looking at my future.
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1 ReactionI have severe thoratic and lumbar stenosis . I have elected to do a minimally invasive Laminectomy on the Thoracic spine L4 and L5 my doctor explained the differences of various options and I did research regarding my symptoms and according due to my symptoms and recearch. I feel this surgery will be sufficient so as to maintain my standard of living however I will have to slow down and be carefull. I am 75.
@debbc
Hi, love the eastern sierras!
I go to Melanie Henry, a pain doctor. We started with regular epidurals then switched to the CT 3 D image ones. Wish we had done that one sooner. But I like Dr. Henry! Good luck!
Thank you, Willow.
I’ve made a note of Dr Melanie Henry. The eastern sierras are like living in a landscape painting, but the medical services are thin.
I’m sure you were referred to Dr Henry; were you seeing a UCSF spine specialist, if so who.
Thanks for your help. Plz let me know if you are in the area of Crowley Lake.id love to meet up
Debb
My husband had the MILD procedure in March 2025 for buttock and leg pain. Walked out with no pain and still one year later pain free in that area. He still has back issues but that procedure took that pain away. Very pleased, quick procedure and no side effects afterwards. For him it was a blessing.
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2 Reactions@melhen Also always try a laminectomy before fusion.
UPDATE from OP: Consulted two more surgeons for other opinions than that of surgeon 1, who said I needed laminectomy with fusion, and that he would not do laminectomy without fusion because it would fail.
Surgeon 2 said I could do a laminectomy alone, and I might not need fusion for many years.
Surgeon 3 initially said laminectomy with fusion but I when I objected to that said he could do a laminectomy alone, and if he did so, he would do it minimally invasively.
Both surgeons said there was no rush to do anything since I'm not in agony, and I could try playing in my upcoming softball season. Both were dismissive of MILD, saying this was procedure done by pain docs and not surgeons, and saying while it might work for some, they end up seeing people who whom it didn't work, and that it makes their laminectomies and such harder to do.
I may see a MILD guy to hear him out, but I'm more skeptical of that then I was before. (Though of course, surgeons are going to be generally biased against such things I would think.)
@jackiet
Did the MILD procedure relieve your pain much?
Going to see a Neurologist at Pain Center this week who performs this. Thank you
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1 Reaction@jpeach It did not relieve my pain much. I can perhaps stand and walk for longer periods of time than before the procedure. I have scoliosis and advanced arthritis. The MILD procedure treats stenosis only as I understand it. The canal stenosis at L4 L5 that was treated was moderate. Maybe those with severe stenosis would have better results.
@jackiet
Thanks for your response.
I'm glad you can stand and walk longer at least.
I have severe spinal stenosis at L4/ L5 .
PAIN IS A PAIN!
Will meet with both Pain Dr and Ortho Surgeon to hear all options. Take care
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